Grayanotoxin poisoning from Rhododendron simsii in an infant

We report a case of severe poisoning in a 57-day-old infant who presented with vomiting, convulsions, and shock after ingesting a bottle of milk containing a decoction of Rhododendron simsii. The grandmother collected this toxic plant from a cultivated area, believing it was good for the airways. Grayanotoxin was detected in both the urine and plant specimens. The infant made a good recovery after requiring ventilatory support for 2 days. Rhododendron is a common gardening shrub in Hong Kong. Some Rhododendron species are poisonous and contain grayanotoxin. Intentional or accidental ingestion of toxic plants can be severe or even life-threatening. It is therefore essential that clinicians be familiar with local toxic plant species.     

Severe congenital lead poisoning in a preterm infant due to a herbal remedy

A preterm infant born to a woman with chronic lead poisoning was found to have the highest blood lead level recorded for a surviving neonate. Parenteral calcium disodium edetate, but not oral succimer, was effective in reducing the infant's lead burden in the neonatal period. An exposure assessment revealed the mother's long-term ingestion of lead-contaminated herbal tablets as the source.     

Adult lead poisoning from a herbal medicine

A 56-year-old Indian lady presented with one week history of abdominal pain, jaundice and chronic polyarthralgia. She had evidence of hemolytic anemia and hepatitis. Her blood lead level was high and a peripheral blood film showed dense basophilic stippling. It is believed that the lead toxicity was due to the use of Indian herbal medicine.     

Anti-Diego a red blood cell alloantibody as a possible cause of anemia in a 3-week-old infant

Our aim in this case report was to describe anemia caused by anti-Diego(a) red blood cell (RBC) antibody in a 3-week-old infant derived during pregnancy to low-frequency Diego(a) RBC antigen. Pre- and postnatal maternal serum screening for unexpected RBC antibodies and determination of RBC antibody specificity in the sera of the mother and child and in the elute of the child were performed by use of microcards (Diamed, Basel, Switzerland; BioVue, Ortho Clinical Diagnosis, Raritan, NJ, USA) with commercially prepared test RBCs (Diamed, Ortho Clinical Diagnosis, and Gamma Biologicals, Houston, TX, USA) at 37 degrees C and indirect antiglobulin test (IAT) according to manufacturer instructions. Direct antiglobulin test (DAT) was performed by use of microcards (Diamed, Ortho Clinical Diagnosis) with both polyspecific and monospecific IgG anti-human globulin. Di(a) antigen was determined on maternal, paternal, and infant's red cells by commercial reagent (Gamma Biologicals). Determination of RBC antibody specificities in maternal and child sera and in the child's RBC eluate showed 2+ positive reactions only with two Di(a+) test RBCs. Father and baby were positive and mother was negative for Di(a) antigen. When a newborn has positive DAT and there are no clinical reasons for this, the possibility of positive DAT resulting from alloimmunization to low-frequency RBC antigens should be considered.     

Acute poisoning: an update.

Treatment of the patient who has taken an overdose of a harmful substance includes support of vital functions and toxicologic analysis. Early recognition of signs and symptoms indicating poisoning by a specific agent or group of related chemicals is essential since specific antidotes may be lifesaving. Activated charcoal is an effective gastrointestinal decontaminant that adsorbs many common drugs. Administration of weak acids as an antidote to alkali ingestion is to be condemned; the only treatment should be dilution with water. The use of physostigmine as a specific antidote for the anticholinergic syndrome has been very successful; the incidence of this syndrome as a result of poisoning by tricyclic antidepressants is increasing. Effective therapy for acetaminophen overdose is still being investigated, but activated charcoal and methionine, if given early enough, seem to be effective.